| NPI | 1366894461 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401416665) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000283) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2019-09-06 |